This has probably been covered before but I missed it so please bear with me. I got to work the other night and had a male pt. in his mid forties who was newly admitted earlier in the day. After report I started browsing through his chart on the computer and noticed an entry in the nurses notes that stated a 20ga. angiocath had been inserted in his wrist x11 attempts. Huh? Must be a double clutch on the number 1 key, right? I looked at the IV assesment tab and there it was again - 11 attempts, all by the same nurse. I might add there was no mention of dehydraton or edema anywhere in the dx. or notes.
I went to the pt.'s room and found a very unhappy camper. He was very vocal about being stuck so many times and his wife was almost in tears over the incident. I started checking him over and to me his veins didn't look all that bad, except for the bruises where he had been stuck. I went back to the nurses station and asked the charge nurse about this and she told me that that particular RN is known for multiple attempts. She said there have been a number of complaints about this very subject but since she is married to one of the county comissioners who oversee the hospital nothing is ever done. (God love small town politics!)
The nurse in question is an older RN who works prn as a charge nurse. She will not allow anyone else to start IVs when she is around. There was at least one other RN, a couple of LVNs, and a couple of EMTs in house at the time but she refused to ask for help. No one was aware of what was going on until it was over.
My question is, how many attempts is too many? How many attempts do you make before you call in someone else to try? My own personal rule of thumb is three strikes and I let someone else take a stab at it. (Sorry about that)
I might add the site infiltrated later in the night. I restarted it in the other forearm on one try. It was still working 48 hours later.
I have deep veins + a layer of fat over them , I always let nurses or lab techs know I have deep veins. Most of the time is takes 2-3 tries to find the vein. If someone gets it on first try(that's rare for me), I'm so happy I always tell them they're very good or just lucky:yeah:. Usually they take a few minutes to look, put 2 elastic bands, slap my forearm and sometimes even inflate the BP cuff to find my veins. I feel kinda bad when someone can't get it in on the 3rd try not only because I'm in pain but also because I see then getting nervous, and it makes me nervous thinking how I'll be doing it when I'm in their shoes, scary and nerve wrecking!
Why can't someone invent some sort of "vein detector"? like some special light that you shine on the forearm and the veins become more visible...That would be so cool and useful.
Specializes in multispecialty ICU, SICU including CV.
Why can't someone invent some sort of "vein detector"? like a so special light that you shine on the forearm and the veins become more visible...That would be so cool and useful.
They have these. It's called a transilluminator -- the brand name is VenoScope. They are REALLY cool.
To the OP -- usually I'll try twice, maybe 3 times. I'm a good stick and if I can't get it after that many tries, it's time to pass it off.
11 sticks is shameful. I'd be embarrassed to document that, and actually, I'm surprised she did.
I rarely get to do them an when I do try have been through 4 people before me. I miss occasionally but I wouldnever try 11 times. We have one male nurse that is a huge body builder, he could start an IV on a turnip and get blood. Either I will get him or Anesthesia to start our hard sticks.
Specializes in multispecialty ICU, SICU including CV.
Really? that's great! How come nurses don't use that?
Not everywhere has them. We don't have them on the floor or in the ICUs. The IV team people are the only ones that carry them. Sometimes if I have someone that looks hard (we do all our own starts in the ICU, if they don't have a line) I'll just call them and have them come up so I can borrow it. They are really slick and not a huge investment -- a couple hundred bucks.
I try 2 times, and then I'm done. Now, my DON on the other hand....Can we say sewing machine? It's pretty difficult to watch, when inside you're screaming, "STOP! STOP! STOP!!!!" I've seen her do 10-12 sticks in a row w/ the same needle.
Specializes in Peds, PACU, ICU, ER, OB, MED-Surg,.
I've worked peds for a long time but have started numerous adults too. I stop at 2. Call someone else after 2, you have no confidence and neither does your patient.
I personally am a very hard stick and have had 22 sticks one time for surgery, not all by the same person, and many by anes. who believe they are the best. I don't even tell them anymore, because I've noticed it makes them nervous if I do and I end up with even more sticks.
I've worked peds for a long time but have started numerous adults too. I stop at 2. Call someone else after 2, you have no confidence and neither does your patient.
I personally am a very hard stick and have had 22 sticks one time for surgery, not all by the same person, and many by anes. who believe they are the best. I don't even tell them anymore, because I've noticed it makes them nervous if I do and I end up with even more sticks.
that is why I ask for inhalation anesthisia when I have surgeries. I am a hard stick and am needle phobic. bad combo
Not everywhere has them. We don't have them on the floor or in the ICUs. The IV team people are the only ones that carry them. Sometimes if I have someone that looks hard (we do all our own starts in the ICU, if they don't have a line) I'll just call them and have them come up so I can borrow it. They are really slick and not a huge investment -- a couple hundred bucks.
exactly, I just looked it up too $200. If each floor had just one machine for those hard to stick cases, people wouldn't have to be poked 11 times.
RPN_2012
259 Posts
I have deep veins + a layer of fat over them
, I always let nurses or lab techs know I have deep veins. Most of the time is takes 2-3 tries to find the vein. If someone gets it on first try(that's rare for me), I'm so happy I always tell them they're very good or just lucky:yeah:. Usually they take a few minutes to look, put 2 elastic bands, slap my forearm and sometimes even inflate the BP cuff to find my veins. 
I feel kinda bad when someone can't get it in on the 3rd try not only because I'm in pain but also because I see then getting nervous, and it makes me nervous thinking how I'll be doing it when I'm in their shoes, scary and nerve wrecking!
Why can't someone invent some sort of "vein detector"? like some special light that you shine on the forearm and the veins become more visible...That would be so cool and useful.